AB0133 DYSAUTONOMIA IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A CROSS-SECTIONAL STUDY
Authors: S. Barak Lanciano, U. Nussinovitch, Y. Levy
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disease associated with increased cardiovascular risk. Impaired autonomic nervous system (ANS) function (dysautonomia) is one of the causes and a marker of increased cardiovascular risk. Heart rate variability (HRV) is an accepted method of ANS evaluation. Pupillary light reflex (PLR) test is indicative of ANS dysfunction in healthy adults. The efficiency of PLR test for ANS evaluation among SLE patients has yet to be reported. <h3>Objectives</h3> To evaluate ANS function among SLE patients using PLR and HRV testing. The secondary objective was to assess the correlation between PLR and HRV tests among patients with SLE and to evaluate whether they are correlated. <h3>Methods</h3> A cross-sectional study was conducted. Forty-nine SLE patients and a matched group of 87 healthy volunteers were recruited. The participants were questioned about risk factors and other conditions that affect the ANS. Autonomic functions was evaluated by HRV and PLR testing. Strength of correlations were also evaluated. <h3>Results</h3> Maximum pupil diameters (PDmax) and maximal constriction velocity (MCV) was significantly lower in the SLE group (4.80±0.13 mm vs. 5.59±0.15 mm, p&lt;0.01 and 4.01±0.44 mm/s vs. 5.94±0.51 mm/s, p&lt;0.01, respectively). Compared with controls, the SLE patients had significantly lower values of NN50 (number of successive RR intervals that differ by more than 50ms, 12.78±3.78 vs. 25.08±2.84, p = 0.031), pNN50 (percentage of pNN50, 4.03±1.30 % vs. 8.84±0.98 %, p&lt;0.01), SDNN (standard deviation of interbeat intervals, 38.44±3.19 ms vs. 50.19±2.39 ms, p&lt;0.01) and HRV triangular index after 5 minutes standing (11.19±0.63 vs. 14.27±0.47, p&lt;0.01). <h3>Conclusion</h3> Patients with SLE have excessive parasympathetic activity, manifested as decreased HRV parameters and indices reflective of heart rate response to autonomic maneuvers. Similar results demonstrated by pupillary autonomic function. PLR test may be used as an alternative to HRV testing due to its simplicity and reproducibility. <h3>References</h3> [1]Bortoluzzi A., et al. Review Peripheral nervous system involvement in systemic lupus erythematosus: a review of the evidence. <i>Clinical and Experimental Rheumatolog</i>y 2019; 37: 146-155. [2]Matusik P.S., et al. Cardiovascular reflex tests in patients with systemic lupus erythematosus: clinical performance and utility. <i>Lupus</i> 2018; 27(11): 1759–1768. [3]Poliwczak AR, et al. The use of heart rate turbulence and heart rate variability in the assessment of autonomic regulation and circadian rhythm in patients with systemic lupus erythematosus without apparent heart disease. <i>Lupus</i> 2018; 27: 436–444. [4]Chen J., et al. Heart involvement in systemic lupus erythematosus: a systemic review and meta-analysis. <i>Clinical Rheumatology</i> 2016; <i>35</i>(10): 2437–2448. [5]Thanou A., et al. Impact of heart rate variability, a marker for cardiac health, on lupus disease activity. <i>Arthritis Research &amp; Therapy</i> 2016; 18(197): 1–10. [6]Yorgun H, et al. Evaluation of cardiac autonomic functions in patients with systemic lupus erythematosus. <i>Lupus</i>. 2012 Apr; 21(4):373-9. [7]Rovsing C, et al. Deep Breathing Increases Heart Rate Variability in Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus. <i>J Clin Rheumatol</i>. 2021 Oct 1; 27(7):261-266. [8]Başaran Ö, et al. Heart rate variability in juvenile systemic lupus erythematosus patients. <i>Turk J Pediatr</i>. 2019; 61(5):733-740. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.